Sample Record for 2025-11-18-31
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 1000258 DEA: 042K3604 EFIS: 0416000410
QA Service Level: 1
DIST-CO-RTE-PM: 04-SON-116-9.6
Work Description: REPAIR SIDE SLOPE AND CONSTRUCT SOIL NAIL WALL.
Location Description: SONOMA COUNTY NEAR MONTE RIO AT 0.2 MILE WEST OF CNOPIUS ROAD
Contractor Name: GHILOTTI BROS., INC.
Contractor Address: 525 Jacoby Street, San Rafael, CA 94901
Resident Engineer: Leonard Brajnikoff Structure Rep.: Alireza Jamalipour
Sample Information
DIME Sample ID: 2025-11-18-31
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Threaded Bar
Sample Taken Date: 11/18/2025
Date that the sample was received by the laboratory/organization performing the testing: 11/24/2025
The quantity of what the sample constitutes: 20
A brief description of the sample: #11 Grade 75 Epoxy Coated All-Thread Bar
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Williams Form Engineering-SD
Material Information
Production or Authorization Testing: Production Testing
Threaded Bar Specification: ASTM A615
Threaded Bar Grade: 75
Threaded Bar Type: Deformed
Rebar Size: #11
Nut Specification for Threaded Bar: ASTM A29
System Manufacturer: Williams Form Engineering San Diego
Epoxy Coating Color: Purple
Threaded Bar Application: Soil Nail
Coating Standards: ASTM A934 epoxy
Bar Heat Number(s): 1000128139
Nut Heat Number(s): 74124863
Bar Lot Number:
Nut Lot Number:
Coupler Heat Number(s):
Coupler Grade:
Test Results
Test 1 of 1
DIME Test ID: 2025-11-18-31-1
Test Method: ASTM A615-20: Standard Specification for Deformed and Plain Carbon-Steel Bars for Concrete Reinforcement (Tensile)
Submitted By Organization: Kleinfelder - Rancho Cordova
Organization Address: 3130 Kilgore Road,
Organization City: Rancho Cordova
Organization State: CA
Organization Zipcode: 95670
Organization Email: mmlee@kleinfelder.com
Organization Phone: (916) 308-3701
Data has not been verified.
